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Inside This Issue:

When Do You Stop Eating?
The Habits of Successful Patients
Eating for a Healthy Heart
Finding Your Internal Motivation
Heart Healthy Recipe
Patient Highlight
CoolSculpting Featured on Dr. Oz

When Do You Stop Eating?

by David Oliak, M.D.

For LAP-BAND patients, this is often a revealing question. When you eat, what determines when you are done? Is it determined by when your plate is empty, when you feel satisfied after a predetermined small portion, or when your band won't allow you to eat more?

If you eat until you have finished your plate and your portion size is large, either your band is not tight enough, or you are not paying enough attention to portion size or when your hunger has subsided. Often patients eat more than they need to "because they can." Try stopping at a smaller, pre-determined portion. Pay attention to the amount you serve yourself. You may be surprised that you are satisfied after a smaller amount. If not, tightening the band may be helpful.

If you eat until your band won't allow you to eat more, your band is too tight. When you feel this way, your pouch is too full. This might help you to eat small amounts and lose weight, but it also puts excessive strain on your esophagus and pouch, and will eventually result in complications like esophageal dysmotility and dilation.

If you eat until you feel satisfied after a predetermined small portion, you are doing things correctly. This tells us your band is at the right tightness, and you are focusing on the right things, namely portion control, eating slowly, and feeling satisfied (not full). Remember, your band is designed to allow you to eat small portions with less hunger. It is not designed to cause discomfort or force you to stop at a certain amount of food. Next time you have a meal, ask yourself, "When do I stop eating?"

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The Habits of Successful Patients

by Allison Merriman, MMSc., PA-C

Over the past 5 years or so, I have asked many successful patients what they think is the key to doing well long term. I've heard a number of effective strategies and habits. Interestingly, their definition of success varied tremendously. Some defined their success as an amount of weight loss that allowed them to be a better mother, spouse, friend, etc. Yet others didn't feel like a "success" until they reached a particular number on the scale. Then again, others will be "successful" because they have eliminated their high blood pressure and no longer have to take medications.

"Success" with your weight loss can be defined many different ways and does not necessarily correlate with your degree of success in life, work, or relationships. Sometimes what you think is "success" is based on what others have told you success is. Importantly, you need to define for yourself what "successful weight loss" means to you. Once you define it, you will know when you've successfully achieved it.

After speaking with many patients who define themselves as "successful with weight loss" long term, a few themes regarding their habits emerged.

1. They define their own success (and not always before their weight loss surgery). Sometimes this occurred during their process and evolved over time. In defining your own success, think about whether your definition is reflective of who you are and what you truly want. Forget the expectations of others. Your definition of success may not be the same as your parents, your teachers, your friends, or your doctors. What do you want to accomplish with your weight loss? Does it inspire you to commit to working hard to achieve it? Remember to preserve some balance in your life. Generally speaking, weight loss goals are very important but can be bittersweet if acquired at the expense of your other values, relationships, or health.

2. They don’t live on “hope.”   Instead of "hoping" the weight will finally come off and "hoping" they won't be hungry and "hoping" they will be thin quickly, they do the things they need to make it happen. Generally, most have a plan and have developed certain habits and behaviors that help them accomplish it.

3. They embrace repetition. In part, this helps them have consistency with their good habits. For example, they often say "I always have a shake for breakfast" or "I always weigh myself every morning," or "I always plan my meals the night before," or "I walk every morning." Although having the same foods and routine can be monotonous, it can indeed help you stay out of trouble. I find most patients stick with the same 10-15 foods and occasionally have something "out-of-the-box." Repetition can definitely be a good thing.

4. They are good at saying "No." Successful patients also seem to do well setting boundaries and saying no. They don't fall into the same traps that contributed to their obesity (you know...birthdays at work, overeating at celebrations, etc). They learn to be content saying no or having a few small bites of "bad foods." Perhaps this has much to do with changing their relationship with food. Simply stated, they stay mindful of what they put in their mouth. Sometimes this involves food journals or just making conscientious choices consistently. Fortunately, life is good and there are ample and frequent opportunities to eat the wrong foods or too much. Learning to say no and make good choices (the majority of the time) is essential.

I hope that by reading some of these "habits of successful patients," you are motivated to continue to work hard towards your own success. While you contemplate what you truly desire, what you are willing to do to achieve your weight loss success, and what you are dedicated to becoming...you may remember (and again recognize) the remarkable person you already are.

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Eating for a Healthy Heart

by Alexandra Mark, RD

The holiday season is a much-needed time for relaxation and reflection. Typically, the last thing on our minds is our health as we allow ourselves to indulge in holiday treats with family and friends. Fortunately, there are ways to enjoy yourself during the season while simultaneously staying on track with your health and weight loss goals. In addition to feeling better, weight loss helps protect you from the country's number one killer-heart disease, which claims nearly 900,000 lives per year. In the main type of heart disease, a fatty substance called plaque builds up in the arteries that bring oxygen-rich blood to the heart. Over time, this buildup causes the arteries to narrow and harden. When this happens, the heart does not get all the blood it needs to work properly. The result can be chest pain or a heart attack.

In order to protect yourself from cardiovascular disease you must be equipped with the proper knowledge. Understanding what the risk factors are and what dietary and behavior changes you can implement to protect yourself are important. Risk factors are conditions or habits you have that increase your chances of developing heart disease or worsening an existing heart condition. Certain uncontrollable risk factors include family history, age or gender. Other risk factors include smoking, diabetes, high cholesterol, high blood pressure, limited physical activity, and obesity.

Dietary changes are also critically important when it comes to protecting yourself. A recent study published in the American Journal of Clinical Nutrition assessed the eating behaviors of over 90,000 women aged 50-79 years of diverse ethnicity and backgrounds. The study's aim was to determine the relationship between a healthy diet and reduced risk of cardiovascular events, such as having a heart attack or stroke. Results revealed that the women who adhered to a low fat diet rich in fruit and vegetables had significantly lower cardiovascular events and less cases of heart failure. This study, along with other research, also indicated that eating a high-fiber diet is one of the most important steps you can take for improving your cardio health and longevity.

Another published study from the National Institutes of Health showed that a high intake of plant fiber each day is strongly linked to longevity. This study involved about 390,000 adults and found that a diet rich in fiber from whole plant foods supported a healthier life expectancy. Plant fiber, which is present in many foods including vegetables, fruits, berries, beans, nuts, and whole grains helps to move food efficiently through the digestive tract and also supports healthy blood, cholesterol and sugar levels.

Although we can't change our genes, we can change our food choices in order to maintain a healthy heart. Try to have at least one fruit or vegetable at each meal in addition to your protein choice. Also be picky about your protein to avoid excess saturated fat, nitrates and too many calories. Beans, fish, and lean meat are healthy sources of protein that also contain disease-fighting nutrients. Other healthy options include boneless, skinless poultry, vegetarian products, and tofu.

It is also vital to know the difference between "healthy" and "unhealthy" fats. High intakes of saturated fat (the kind found in butter, cheese and red meat) can lead to increased levels of bad (LDL) cholesterol, which increases the risk for heart disease. You should decrease your intake of full-fat meats such as prime rib, bacon, processed lunch meats and regular ground beef to avoid consuming too much saturated fat. You should also avoid full-fat dairy products, such as "whole" milk, yogurt, cream, cream cheese and ice cream. Although dairy provides us with healthy protein and calcium, you want to choose reduced fat, low fat, or fat free products. Unlike saturated fats, monounsaturated fats can lower LDL cholesterol levels in your blood and reduce the risk of heart disease and stroke. Examples of foods high in monounsaturated fats include olive oil, avocados and almonds. Omega-3 fatty acids, a type of polyunsaturated fat, may also decrease your risk of heart attack, protect against irregular heartbeats and lower blood pressure. Certain fish, such as salmon and mackerel, are a good natural source of omega-3s. Omega-3s are present in smaller amounts in flaxseed oil and walnuts.

Water can also significantly lower the risk of heart disease and stroke. Recent studies show that water slightly raises your metabolism and fills you up, helping you avoid overeating and the excess calories that come with the winter holidays. So don't forget, as you enjoy your holiday season, how easy and important it is to stay hydrated and happy with filtered water.

Instead of dwelling on things that you cannot control, try to focus on the things over which you have power. Realize that you can choose to move more and eat better and maintaining healthy lifestyle choices will greatly reduce your risk of developing or exacerbating heart disease. This year, as you raise your glass in a toast to your family and friends, consider starting a new tradition of choosing holiday meals that are both delicious and heart-healthy. Fill your heart with love, friendship, and healthy foods this holiday season!

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Finding Your Internal Motivation

by Danielle Garcia, PsyD.

We all know that it takes a great deal of motivation to successfully lose weight. However, it is important to have a good understanding of the type of motivation that can aid in our weight loss success. A recent study examined how motivation might be a large contributor in sticking with weight loss programs. The researchers compared autonomous (internal) motivation, defined as the feeling that self-control is the best way to help oneself make changes with controlled (external) motivation, which is defined as motivation from external controls such as perceived pressure from others and feelings of guilt. The authors found a positive correlation between weight loss and higher levels of autonomous motivation. In other words, individuals who were internally motivated to lose weight lost more weight than individuals who were externally motivated to lose weight.

Internal motivation is one of the most effective tools to help with your weight loss. No matter how much encouragement you receive from the outside (be it positive or negative!), it still won't be effective if you fail to believe that you can succeed. My goal for each and every one of you is for you to find your internal motivation for weight loss. Here are a few ways that you can begin to identify what those internal motivators are for you.

Know what your main motivation is for losing weight

Just saying that you want to weigh less is not enough of a motivator to "stick to" a weight loss plan. That is because the number on the scale is an external motivator. You need to know why you want to lose weight, and how weight loss relates to your bigger goals in life. For instance, you can tell yourself that you want to lose weight because you're tired of having low self-esteem. Losing weight will increase your self-esteem and help you regain your self-confidence so you can better handle the other areas of your life. Many patients tell me that they feel their excess weight is holding them back in numerous social situations. Losing weight and having a greater sense of self-confidence may begin to open up doors that had seemed sealed shut!

Practice Positive Self-Talk

Ever found yourself saying that you will never be able to lose the weight? Or told yourself that you would never be able to exercise comfortably? Filling our minds up with all of the negative thoughts about ourselves and our weight loss can be a huge detriment to our success. Rather than thinking of all the things you "can't" do, reframe the thought to say, "I currently struggle with," or "I am working to improve on." The more we are able to encourage ourselves with positive self-talk; the more likely we are to keep working toward our goals. Remember, your self-talk can either make you your own best friend or your own worst enemy. Which would you rather be?

Focus on the Benefits

Take some time (today...RIGHT NOW!) to write down the personal benefits that weight loss will bring you. This list should consist of all the good things that you can expect to gain once you've successfully lost weight. This could include things like being able to fit into smaller size clothing, being more physically active, having more protection against chronic diseases...and the list goes on and on! Keep a copy of your list in your journal and look at it daily. Nothing is more motivating than the constant reminder of why you are working so hard to improve your health. Here's a little tip: if you find that you haven't looked at your list in a while, take some time to evaluate why. Most people admit that they avoid their motivational lists when they have "slipped" and they don't want to feel guilty. Rather than avoiding your list at these times, use it to help you get right back on track!

Remind Yourself of Your Successes

Another way to keep your internal motivation going is to give yourself credit for all of your successes, no matter how small. For example, if you drive past the place where you used to stop for an unhealthy snack, tell yourself that you did a good job! If you go down a pant size, call a supportive friend and tell them about your victory! Every time you give yourself credit for your success, you are reinforcing your internal motivation.

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Heart Healthy Recipe

Chicken with Sugar Snap Peas & Spring Herbs

From EatingWell for a Healthy Heart Cookbook (2008)

Ingredients:
1 cup reduced-sodium chicken broth
1 teaspoon Dijon mustard
1/2 teaspoon salt
Freshly ground pepper to taste
2 teaspoons plus 1 tablespoon flour, divided
1 pound thin-sliced chicken breast cutlets
1 tablespoon extra-virgin olive oil
8 ounces sugar snap peas, cut in half (2 cups)
1 14-ounce can quartered artichoke hearts, rinsed
1/4 cup sprouted beans, (see Note), optional
3 tablespoons minced fresh herbs, such as chives, tarragon or dill
2 teaspoons champagne vinegar, or white-wine vinegar

Directions:

1. Whisk broth, mustard, salt, pepper and 2 teaspoons flour in a small bowl until smooth.

2. Sprinkle both sides of the chicken with the remaining 1 tablespoon flour. Heat oil in a large nonstick skillet over medium-high heat. Cook the chicken in two batches, adjusting heat as necessary to prevent burning, until golden, about 2 minutes per side. Transfer the chicken to a plate; tent with foil to keep warm.

3. Stir the broth mixture and add to the pan along with snap peas, artichoke hearts and sprouted beans (if using). Bring to a simmer, stirring constantly. Reduce heat to maintain a gentle simmer and cook until the snap peas are tender-crisp, 3 to 5 minutes.

4. Return the chicken to the pan, nestling it into the vegetables, and simmer until heated through, 1 to 2 minutes. Remove from heat; stir in herbs and vinegar.

Tips & Notes

Sprouted beans, not to be confused with bean sprouts, are beans that have just barely sprouted—they look like a bean with a tiny fiber attached (rather than the more fleshy-looking sprouts commonly used in Asian cooking). Eat raw in salads or add to cooked dishes; they're an excellent source of fiber and protein. Look for them in the produce section near other sprouts.

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Patient Highlight

My name is Holly and I had my surgery on February 4, 2011. I have yet to reach my goal weight, but I can see the light at the end of the tunnel! I am down 64 pounds and am aiming for 26 more. When I tell people that I have had Lap Band surgery, I feel as if they think I took the easy way out. By no means has this been easy. In fact, I still feel like it's a struggle on many days!

Here are some things I find important on my weight loss journey:

1. Keeping a food journal and trying to stay within 1000-1200 calories a day. I know there are days I could go way over if I were not keeping good track of what I was eating.

2. Weighing and measuring my food. Sometimes I find it amazing what a "real" serving size is!

3. Planning ahead. Whether it is my food for the following day or looking up the nutritional information for a restaurant I am going to, this has proved helpful for me.

4. UtiIizing the support of others. This includes everyone at Dr. Oliak's office, the Monday night meetings, and most importantly, the friends I have made through this office.

I am so happy that I made the decision to go forward with the surgery and that I went to Dr. Oliak's office. Everyone's support here has been a huge part of my weight loss success and for that I am very thankful.

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CoolSculpting Featured on Dr. Oz!